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Poor Risk Advanced Renal Cell Carcinoma: Outcomes from a Registry in a Tertiary Cancer Center
Anant Ramaswamy1, Amit Joshi1, Vanita Noronha1
1Department of Medical Oncology, Radiology,Nuclear Medicine and Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Background:
Poor-risk advanced Renal cell carcinoma (RCC) are an under-evaluated and difficult to treat subset of patients with poor prognosis. While Temsirolimus is the approved first line therapy for this category, Tyrosine kinase inhibitors (TKIs) are also commonly uses as initial treatment. We present an analysis of poor-risk advanced RCC treated in our institute.
Materials And Methods:
Patients diagnosed as poor-risk (as per Heng criteria) advanced RCC from June 2008 to December 2015 were analysed for baseline demographics, treatment received, toxicity (primarily Grade 3 and Grade 4), response rates (RR) and survival.
Results:
60 patients (43 males, 17 females) with a median age of 53 years were included for final analysis. Median ECOG PS was 1, clear cell was the predominant histology (63.3%), and 46.7% of patients had greater than 2 sites of metastases. Sorafenib, Sunitinib, Temsirolimus and Pazopanib were used to treat 43.3%, 36.7%, 8.3% and 6.7% of patients respectively, while 3 patients were offered upfront best supportive care. Common adverse events included skin rash (31.5%), HFS (Grade 2 and 3 - 30.8%), mucositis (26.3%), hypertension (24.5%), and dyslipidaemias (22.8%). 41 patients were available for response - overall response rate observed was 15%, while clinical benefit rate was 50%. Median progression free survival was 5.78 months (4.67-6.89) and median overall survival (OS) was 10.05 months (7.31-12.79).
Conclusion:
A majority of poor-risk metastatic RCC patients in our study were treated with TKIs and the survival outcomes appear to suggest that this strategy is a feasible alternative to Temsirolimus in the Indian setting.
Insights
Tyrosine kinase inhibitors (TKIs) offer a feasible first-line treatment for poor-risk advanced Renal Cell Carcinoma (RCC). This analysis of advanced RCC patients indicates comparable survival outcomes to Temsirolimus in the Indian context.
Area of Science:
- Oncology
- Medical Research
Background:
- Poor-risk advanced Renal Cell Carcinoma (RCC) presents a significant treatment challenge with a poor prognosis.
- Temsirolimus is the standard first-line therapy, but Tyrosine Kinase Inhibitors (TKIs) are also frequently used.
Purpose of the Study:
- To analyze the treatment outcomes of poor-risk advanced RCC patients treated at our institute.
- To evaluate the efficacy and safety of TKIs as a first-line treatment for this patient subset.
Main Methods:
- Retrospective analysis of 60 poor-risk advanced RCC patients (diagnosed June 2008-December 2015) based on Heng criteria.
- Data collected included demographics, treatment received (TKIs, Temsirolimus), toxicity, response rates (RR), progression-free survival (PFS), and overall survival (OS).
Main Results:
- The majority of patients received TKIs (Sorafenib, Sunitinib, Pazopanib).
- Overall response rate was 15%, with a clinical benefit rate of 50%.
- Median PFS was 5.78 months and median OS was 10.05 months, with manageable toxicity.
Conclusions:
- Tyrosine Kinase Inhibitors (TKIs) represent a feasible first-line treatment strategy for poor-risk advanced RCC in the Indian setting.
- Survival outcomes suggest TKIs are a viable alternative to Temsirolimus for this patient population.
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